Sex differences in recovery from PTSD in male and female interpersonal assault survivors

doi:10.1016/j.brat.2013.02.002

Behaviour Research and Therapy

Volume 51, Issue 6, June 2013, Pages 247-255

https://doi.org/10.1016/j.brat.2013.02.002 Get rights and content

Abstract

Men and women differ in exposure to trauma and the development of posttraumatic stress disorder (PTSD); however, research regarding sex differences in recovery from PTSD has been sparse. This study evaluated the treatment response trajectory for 69 male and female interpersonal assault survivors, using a modified Cognitive Processing Therapy (CPT) protocol that allowed survivors to receive up to18 sessions of CPT, with treatment end determined by therapy progress. Few sex differences were observed in trauma history, baseline PTSD and depressive severity, Axis I comorbidity, anger, guilt and dissociation. Women did report more sexual assault in adulthood and elevated baseline guilt cognitions, whereas men reported more baseline anger directed inward. Attrition and total number of sessions did not differ by sex. Over the course of treatment and follow-up, men and women demonstrated similar rates of change in PTSD and depressive symptoms. However, medium effect sizes on both of these primary outcomes at the 3-month follow-up assessment favored women. Several differences in the slope of change emerged on secondary outcomes such that women evidenced more rapid gains on global guilt, guilt cognitions, anger/irritability, and dissociation. Results suggest that male survivors may warrant additional attention to address these important clinical correlates.

Section snippets

Current study

Men and women are clearly exposed to trauma differentially, develop psychopathology such as PTSD and depression at different rates, and present clinically with a host of PTSD concomitants such as guilt, anger and dissociation differentially. Far less is known about potential sex differences in treatment outcome, particularly in homogenous trauma samples of PTSD survivors. The current study was specifically designed to evaluate sex differences and, to our knowledge, represents the first study to

Participants and procedure

Sixty-nine participants (22 men and 47 women) sought outpatient trauma-focused therapy following an interpersonal assault. All participants met full criteria for PTSD secondary to a sexual or physical assault as assessed by the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1990). All participants were at least 3 months posttrauma at the time of the initial assessment, and there was no upper limit on time since trauma. Participants were required to be stable on medications for a period

Results

Participants demographic and trauma history comparisons by gender can be found in Table 1. Demographics did not differ by sex. Overall, participants reported a complex trauma history, with lifetime endorsements of child sexual abuse (64%), child physical abuse (57%), adult sexual assault (51%), and adult physical assault (65%). As can be seen in Table 1, lifetime trauma history did not differ by sex, except that women endorsed a higher incidence of adult sexual assault. All participants

Discussion

Although sex differences have been detected in exposure to trauma and in the subsequent development of PTSD, the paucity of research on potential differences in the recovery from this debilitating disorder is apparent in a review of the treatment outcomes literature (Blain et al., 2010). The handful of existing studies examining sex differences are confounded by mixed trauma type, rendering interpretation of sex disparities in outcomes difficult to attribute to sex versus trauma experience. In

Acknowledgments

This work was supported by a National Institute of Mental Health (NIMH) 1R34MH074937 grant awarded to Tara E. Galovski at the University of Missouri–St. Louis. We thank the clinicians and research assistants whose work to make this research possible and the generous individuals who participated in these trials.

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Sex differences in recovery from PTSD in male and female interpersonal assault survivors

Abstract

Section snippets

Current study

Participants and procedure

Results

Discussion

Acknowledgments

Behavior Therapy

Aggression and Violent Behavior

Journal of Anxiety Disorders

Behaviour Research and Therapy

Comprehensive Psychiatry

Journal of Affective Disorders

Behavior Therapy

The Journal for Nurse Practitioners

Behaviour Research and Therapy

A randomized controlled study of single-session behavioural treatment of earthquake-related post-traumatic stress disorder using an earthquake simulator

Psychological Medicine

Single-session behavioral treatment of earthquake-related posttraumatic stress disorder: a randomized waiting list controlled trial

Journal of Traumatic Stress

Beck Depression Inventory

The role of coding time in estimating and interpreting growth curve models

Psychological Methods

A clinician rating scale for assessing current and lifetime PTSD: the CAPS-1

The Behavior Therapist

Trauma-related dissociative states and long-term psychopathology in posttraumatic stress disorder

Journal of Traumatic Stress

Estimating posttraumatic stress disorder in the community: lifetime perspective and the impact of typical traumatic events

Psychological Medicine

Trauma Symptom Inventory professional manual

Gender differences in the relationship between acute stress disorder and posttraumatic stress disorder following motor vehicle accidents

Australian and New Zealand Journal of Psychiatry

Anger in PTSD: general psychiatric and gender differences on the BDHI

Journal of Loss & Trauma

Anger regulation deficits in combat-related posttraumatic stress disorder

Journal of Traumatic Stress

Applied multiple regression/correlation analysis for the behavioral sciences

Dissociative experiences and posttraumatic stress disorder among female victims of criminal assault and rape

Journal of Traumatic Stress

Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric for classical analysis

Psychological Methods

Effects of gender and ethnicity on self reports of mild, moderate, and severe sexual coercion

Sexuality & Culture

The sexual abuse of boys

Victimology: An International Journal

Structured Clinical Interview for DSM–IV (SCID)

The validation of a self-report measure of posttraumatic stress disorder: the Posttraumatic Diagnostic Scale

Psychological Assessment

Mechanisms of anger and treatment outcome in combat veterans with posttraumatic stress disorder

Journal of Traumatic Stress

Gender differences in posttraumatic stress disorder after motor vehicle accidents

American Journal of Psychiatry